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1 Keep a completed copy of Form TP 550 for your records
1 Tons of hazardous waste generated in New York State that were treated or disposed of on site during
10 Tons of hazardous waste designated for removal or removed from the site of
11 Tons of hazardous waste incinerated on site of generation $ 2 =
12 Total tons of hazardous waste subject to assessments (add Tons column
13 Total assessments for current quarter (add Assessment column lines 7 through 11) If the amount reported
14 Interest due for late payment (see instructions) 14
15 Additional charges for late filing and/or late payment (see instructions) 15
16 Total due (add lines 13 14 and 15) 16
17 Total remittance: Make check or money order payable to the Commissioner of Taxation and Finance 17
2 Attach a check or money order payable in U S funds to: Commissioner of Taxation and Finance
2 Tons of hazardous waste reported on line 1 that were treated or disposed
3 Tons of hazardous waste reported on line 1 that were generated under an
3 Write your identification number Form TP 550 and the quarter covered by this return in the memo area of your check or money order
4 Tons of hazardous waste recovered from a materials recovery process
5 Tons of hazardous waste not subject to assessments (add lines 2 3 and 4)
6 Total tons of hazardous waste subject to assessments (subtract line 5 from line 1)
7 $ 27 =
7 Tons of hazardous waste disposed of in a landfill on the site of generation
8 Tons of hazardous waste designated for removal or removed from the site of
9 Tons of hazardous waste designated for removal or removed from the site of
ALBANY NY 12227 0863
Albany NY 12227 0863 Use this form to report any transactions for the quarter:
Authorized
Change of business information? See Business information in Form TP 550 I
City State ZIP code
Computation of net tons subject to assessment for the quarter
Computation of special assessments on hazardous waste for the quarter
Department of Environmental Conservation
during the reporting quarter for treatment disposal or storage prior to such treatment or disposal 1
E mail address of individual preparing this return
Employer identification number (EIN) or social security number (SSN)
Environmental protection agency (EPA) number
File on or before the 20th day of the month following the end of the quarter
Firm s EIN
Firm s name (or yours if self employed)
generation for disposal in a landfill or storage prior to disposal in a landfill 8 $ 27 =
generation for incineration or storage prior to incineration $ 9 =
generation for treatment or disposal (except by landfill or incineration) or
Hazardous Waste Generated in New York State
I hereby certify that to the best of my knowledge and belief this is a true and complete return
If you choose to use a private delivery service instead of the U S Postal Service see Publication 55 Designated Private Delivery Services
Legal name
lines 7 through 11) 12
Mail this return along with your check or money order to: NYS TAX DEPARTMENT
Mailing instructions
MISC TAX RETURNS PROCESSING
New York State Department of
of on site except by incineration or landfill disposal 2
on line 13 is $27 or less stop; you do not have to file this return or pay the assessments 13
order of or agreement or contract with the New York State
Page 2 of 2 TP 550 (12/14)
person
preparer
Preparer s NYTPRIN
Preparer s PTIN or SSN
Print or type
Quarterly Return for Special Assessments on
Read Form TP 550 I Instructions for Form TP 550 before making entries below
Signature of authorized person Official title
Signature of individual preparing this return Address City
State ZIP code
storage prior to such treatment or disposal 9 $ 16 =
Street address
Taxation and Finance TP 550
the reporting quarter or were removed from or designated for removal from the site of generation
through
Tons (to nearest 1/10 ton) Rate = Assessment
W A Harriman Campus